Surrey Care Record

Surrey Heartlands

Introduction BackgroundSolution
Our platform allows data, communications and work to flow across the professional, organisational and geographical boundaries of the Surrey health and social care system.

The Surrey Care Record is the shared integrated digital care record for Surrey Heartlands and East Surrey CCG. It uses Patient Knows Best (PKB) technology to deliver a professional-facing portal, which will be launched in July 2018.

In Phase 1, GP, acute and pathology records will be made available to GPs and A&E professionals across four CCGs. Soon after, Phase 2 will see the record extended to cover mental health, social care, community, ambulance, and later pharmacy. Shared care plans will also be introduced. The solution includes a data warehouse to support analytics.

Level 2 - Sharing two care settings {inc. GP} at read only
Medium - 5-10 Organisations
FOCUS ON: Health and Social Care Collaboration

“My background is in local government improvement, innovation and integration, so I bring a different perspective to the programme. Health has a good historic relationship with local authority in this area, at county, district and borough level, which helps us ensure we have a balanced agenda encompassing health and care.

I am really excited about the opportunities presented by the Surrey Care Record. Not only in terms of better coordinated care, but also in light of the discussions we’re having in Surrey about the wider determinants of health. Once we start to add other data into the mix, aside from purely health data, we can start to do some powerful analysis.

There is a real appetite for this at a leadership level across the partner organisations, so things are moving forward at pace. We’re working collaboratively to agree how intelligence can be used to improve population health and reduce inequalities in the region. ”

Kat Stolworthy, Associate Digital Director, Surrey Heartlands

  • The Surrey Care Record is an enabler and a beneficiary of the priorities outlined in the Surrey Local Digital Roadmap (LDR), i.e. Devolution, Developing a Clinical Academy and Citizen Engagement.
  • Surrey Heartlands patients frequently cross boundaries to access care provided by other organisations, for example around 50% go to Surrey and Sussex Healthcare NHS Trust (SASH), 20% go to Frimley Park (Frimley Health NHS FT), and a significant proportion receive specialist care (for example treatment for certain cancers) in London hospitals.
  • The Surrey Care Record is based on technology provided by Patients Know Best (PKB). It uses a central repository model to bring together information from underlying clinical systems, and presents it through a professional-facing portal.
  • The programme builds on a smaller-scale deployment of a PKB solution at SASH, integrating with the hospital’s Cerner Millennium EPR, and involving 3,200 inflammatory bowel disease patients.
  • PKB is considered to be a tactical solution and the Surrey team is keen to avoid creating dependencies on individual IT vendors. They wish to maintain flexibility, bearing in mind the STP operating model is likely to change, and IT industry is shifting towards subscription based purchasing models.
  • As well as the professional portal, the Surrey Care Record comprises three key components, aimed at delivering Surrey Heartlands’ long term strategic interoperability goals:
    • Central Integration Engine
    • Enterprise Data Warehouse (a pre-requisite for analytics and intelligence)
    • Clinical Data Store
  • A patient portal is also on the roadmap but exactly what form this will take is still being decided. The aim is to have one point of access for patients – ideally a solution that factors in NHS 111 Online, NHS Pathways, eConsultations, and the Directory of Services. There are still a number of questions to work through, which is another reason to remain open minded regarding vendors.
  • Central Repository Model PKB technology is used to provide a professionalfacing portal
  • The solution enables clinicians to “click through” from their clinical system into the portal
  • Business intelligence and research are also part of the roadmap, and provision has been made for this within the technical architecture

Business Capabilities

Individual Patient Care
  • The aim with the Surrey Care Record is that it should be richly populated from as wide a variety of sources as possible, early on. It is felt that the more information it contains from the start, the more clinicians will be inclined to use it, and the more positive a reputation it will establish, which will drive further clinical uptake.
  • Work has been completed with each of the partner organisations to agree the scope of the data to be shared and understand the opportunities to improve individual patient care through more informed decision making.
Care Planning and Coordination
  • Standardised shared care plans will be introduced in the latter half of 2018, with Mental Health services and the South East Coast Ambulance Trust being the first to contribute. The care plans will be delivered using functionality within the PKB portal. There will be no facility initially to write data entered in this way to underlying systems, although the desire is to achieve this level of integration in the future.
  • A major part of the exercise has been to establish the definition of a “care plan” across different organisations and service types , and to agree a common approach.
Health and Care System Management & Population Health Management
  • There is currently a focus across Surrey on the “wider determinants of health”. The Surrey Care Record is being architected to support intelligence gathering and analytics in this context, and work is underway to determine the non-clinical datasets that may be needed in order to fully understand the individual, social and environmental factors which influence the health of the population.
  • The Surrey team is working closely with Kent County Council in their development of the Kent Integrated Dataset (KID), which is being used to inform health and public health strategies and decisions, test what works and forecast future service pressures and outcomes. Surrey plans to implement the same solution.
  • The Surrey team is also working with the support of a public health consultant to align related programmes such as RightCare, NHSI initiatives, and benefits monitoring, and to understand what influences patients to seek care outside of the Surrey Heartlands area.